Information
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Com Number
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Conducted on
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Prepared by
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Location
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Inspection Date
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Inspection Type
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Person interviewed
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Premises Type
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Owner
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Email address
GENERAL
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Type of Circulation System
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Dosing System
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Secondary treatment system?
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Test Kit Method for testing
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Testing Frequency
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Records log book maintained?
Pool 1
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Disinfectant Type
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Pool size
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Location
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Water temperature (°C)
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Free Chlorine (mg/L)
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Total Chlorine (mg/L)
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Combined Chlorine (mg/L)
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pH range
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Total alkalinity (mg/L)
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Cyanuric Acid
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Comments
Pool 2
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Disinfectant Type
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Pool size
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Location
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Water temperature (°C)
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Free Chlorine (mg/L)
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Total Chlorine (mg/L)
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Combined Chlorine (mg/L)
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pH range
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Total alkalinity (mg/L)
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Cyanuric Acid
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Comments
Pool 3
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Disinfectant Type
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Pool size
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Location
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Water temperature (°C)
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Free Chlorine (mg/L)
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Total Chlorine (mg/L)
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Combined Chlorine (mg/L)
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pH range
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Total alkalinity (mg/L)
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Cyanuric Acid
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Comments
General
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Pool Cleanliness
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Change Room Cleanliness
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Other Comments
RESULTS
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Inspection Result
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Action Required
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Other comments
